=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134673676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERITAS PAIN MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2016
-----------------------------------------------------
Last Update Date | 08/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3726 DACOMA ST SUITE 125
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77092-8906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-835-3003
-----------------------------------------------------
Fax | 713-574-2134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3726 DACOMA ST SUITE 125
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77092-8906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-835-3003
-----------------------------------------------------
Fax | 713-574-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | VANESSA SANCHEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-835-3003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------